Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.
IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.
Front Endocrinol (Lausanne). 2020 Oct 6;11:537205. doi: 10.3389/fendo.2020.537205. eCollection 2020.
The maturation of oocytes to acquire competence for fertilization is critical to the success of fertilization (IVF) treatment. It requires LH-like exposure, provided by either human chorionic gonadotropin (hCG), or gonadotropin releasing hormone agonist (GnRHa). More recently, the hypothalamic stimulator, kisspeptin, was used to mature oocytes. Herein, we examine the relationship between the endocrine changes following these agents and oocyte maturation.
Retrospective cohort study.
Prospectively collected hormonal data from 499 research IVF cycles triggered with either hCG, GnRHa, or kisspeptin were evaluated.
HCG-levels (121 iU/L) peaked at 24 h following hCG, whereas LH-levels peaked at ~4 h following GnRHa (140 iU/L), or kisspeptin (41 iU/L). HCG-levels were negatively associated with body-weight, whereas LH rises following GnRHa and kisspeptin were positively predicted by pre-trigger LH values. The odds of achieving the median mature oocyte yield for each trigger were increased by hCG/LH level. Progesterone rise during oocyte maturation occurred precipitously following each trigger and strongly predicted the number of mature oocytes retrieved. Progesterone rise was positively associated with the hCG-level following hCG trigger, but negatively with LH rise following all three triggers. The rise in progesterone per mature oocyte at 12 h was greater following GnRHa than following hCG or kisspeptin triggers.
The endocrine response during oocyte maturation significantly differed by each trigger. Counter-intuitively, progesterone rise during oocyte maturation was negatively associated with LH rise, even when accounting for the number of mature oocytes retrieved. These data expand our understanding of the endocrine changes during oocyte maturation and inform the design of future precision-triggering protocols.
卵母细胞的成熟获得受精能力对受精（IVF）治疗的成功至关重要。它需要 LH 样暴露，这可以通过人绒毛膜促性腺激素（hCG）或促性腺激素释放激素激动剂（GnRHa）提供。最近，使用下丘脑刺激物 kisspeptin 来成熟卵母细胞。在此，我们研究了这些药物作用后内分泌变化与卵母细胞成熟之间的关系。
回顾性队列研究。
前瞻性收集了 499 个接受 hCG、GnRHa 或 kisspeptin 触发的研究性 IVF 周期的激素数据。
hCG 给药后 24 小时 hCG 水平（121 iU/L）达到峰值，而 GnRHa（140 iU/L）或 kisspeptin（41 iU/L）给药后 4 小时 LH 水平达到峰值。hCG 水平与体重呈负相关，而 GnRHa 和 kisspeptin 给药后 LH 升高与触发前 LH 值呈正相关。每种触发因素达到中位数成熟卵母细胞产量的可能性都随着 hCG/LH 水平的增加而增加。每种触发因素在卵母细胞成熟过程中孕酮的升高都急剧发生，并且强烈预测可获得的成熟卵母细胞数量。孕酮升高与 hCG 触发后的 hCG 水平呈正相关，但与三种触发因素后的 LH 升高呈负相关。GnRHa 触发后 12 小时每成熟卵母细胞孕酮升高大于 hCG 或 kisspeptin 触发后。
卵母细胞成熟过程中的内分泌反应因每个触发因素而异。出人意料的是，即使考虑到可获得的成熟卵母细胞数量，卵母细胞成熟过程中的孕酮升高与 LH 升高呈负相关。这些数据扩展了我们对卵母细胞成熟过程中内分泌变化的理解，并为未来的精确触发方案设计提供了信息。
